Provider Demographics
NPI:1255808234
Name:FUQUAY, CATHY WILSON (RPH)
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:WILSON
Last Name:FUQUAY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8519 HAW RIVER RD
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:NC
Mailing Address - Zip Code:27310-9832
Mailing Address - Country:US
Mailing Address - Phone:336-430-7505
Mailing Address - Fax:
Practice Address - Street 1:8519 HAW RIVER RD
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:NC
Practice Address - Zip Code:27310-9832
Practice Address - Country:US
Practice Address - Phone:336-430-7505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC71701835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist